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Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia

¹ Veterans Evidence-Based Research Dissemination Implementation Center, Audie L. Murphy Veterans Affairs Hospital, ² Division of Pulmonary and Critical Care Medicine, ³ South Texas Veterans Health Care System Audie L., Murphy Division, ⁴ Depts of Medicine, and ⁷ Pathology, Division of General Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, and ⁶ Northwestern University Feinberg School of Medicine, Chicago, IL, USA, ⁵ School of Medicine and Pharmacology Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.

CORRESPONDENCE: M. I. Restrepo, , VERDICT (11C6), South Texas Veterans Health Care System Audie L. Murphy Division, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA. Fax: 1 2105674423. E-mail: restrepom{at}uthscsa.edu

Keywords: Antibiotics, community-acquired pneumonia, outcomes, sepsis

Received: April 8, 2008
Accepted August 12, 2008

Recent studies suggest that macrolides may have beneficial effects for patients at risk for certain infections. The current authors examined the effect of macrolide therapy on 30- and 90-day mortality for patients with severe sepsis caused by pneumonia.

A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of, had chest radiography consistent with, and had a discharge diagnosis of pneumonia and clinical criteria of severe sepsis. Subjects were considered to be on macrolides if they received at least one dose within 48 h of admission.

Severe sepsis was present in 237 (30.1%) subjects, out of whom 104 (43.9%) received macrolides. Mortality was 20.3% at 30 days and 24.5% at 90 days. In the multivariable analysis, the use of macrolide was associated with decreased mortality at 30 days (hazard ratio (HR) 0.3, 95% confidence interval (CI) 0.2–0.7) and at 90 days (HR 0.3, 95% CI 0.2–0.6) in patients with severe sepsis and in patients with macrolide-resistant pathogens (HR 0.1, 95% CI 0.02–0.5).

Macrolide use was associated with decreased mortality in patients with severe sepsis due to pneumonia and macrolide-resistant pathogens. Confirmatory studies are needed to determine whether macrolide therapy may be protective for patients with sepsis.

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